A depressing financial justification

One of the most controversial changes to the recently finalised DSM-5 diagnostic manual was the removal of the ‘bereavement exclusion’ from the diagnosis of depression – meaning that someone could be diagnosed as depressed even if they’ve just lost a loved on

The Washington Post has been investigating the financial ties of those on the committee and, yes, you guessed it:

Eight of 11 members of the APA committee that spearheaded the change reported financial connections to pharmaceutical companies — either receiving speaking fees, consultant pay, research grants or holding stock, according to the disclosures filed with the association. Six of the 11 panelists reported financial ties during the time that the committee met, and two more reported financial ties in the five years leading up to the committee assignment, according to APA records.

A key adviser to the committee — he wrote the scientific justification for the change — was the lead author of the 2001 study on Wellbutrin, sponsored by GlaxoWellcome, showing that its antidepressant Wellbutrin could be used to treat bereavement…

The association also appointed an oversight panel that declared that the recommendations had been free of bias, but most of the members of the “independent review panel” had previous financial ties to the industry.

Actually, it’s kind of sad that this isn’t a surprise, but perhaps more worrying is the fact that the chairman of the mood disorders panel that made the change, Jan Fawcett, doesn’t seem to understand bias.

“I don’t think these connections create any bias at all,” Fawcett said. “People can say we were biased. But it assumes we have no intelligence of our own.

Fawcett is assuming that bias means ‘dishonesty’ where people deliberately make choices for their own advantage against what they know to be a better course of action, or ‘sloppiness’ where people don’t fully think through the issue.

But bias, as you can find out from picking up any social psychology paper from the past century, is where incentives change our behaviour usually without us having insight into the presence or effect of the influencer.

So when someone says, “I don’t think these connections create any bias” it means – ‘I’m not willing to think about the bias that these connections create’ which is a red flag that they won’t be recognised or addressed.

We’re all susceptible to them. The trick is to recognise they exist and put measures in place to account for them.

Sadly, it doesn’t look like this has happened with the DSM-5.

Link to WashPost article on the new depression diagnosis and industry ties.

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7 thoughts on “A depressing financial justification”

What concerns me about the use of antidepressants in cases such as bereavement is the possibility of the antidepressants blocking natural cognitive functions from coming to terms with the loss.
I am an advocate of the use of antidepressants in appropriate situations. But when it comes to matters of altering brain chemistry we are dealing with complex situations which are yet to be fully understood. In this sense I would say that depression and using antidepressants to hold it at bay should only be done when clearcut situations indicate it.
I am assuming that depression at its base state is a natural function of the mind, with a purpose. When depression is blocked wholesale then the purpose of the mental state is interfered with, possibly with quite negative results. It is known that coming off of many antidepressants can cause ideation of suicidality. This in itself should be a very strong warning signal calling for further research into exactly what the antidepressants are doing.

At the end of 2012 the greates floop was publishing DSM V and this is the end if onest psychistrists. Sorry about them but has to happend for changing something! Hope anorher generation will come out from decade of crisis

Bias is a core concept of modern decision making theory. Letting someone who seems to lack insight into modern decision making theory lead a panel that makes a diagnostic manual that is supposed to help clinicians make better decisions about classifying patients is cause for worry.

Another financial incentive is to remove all temporary diagnoses recognized by Social Security for disability determination. DSM is the diagnostic bible used by such agencies and a too-broad scope can result in their demotion as a credible authority.